Portal hypertension differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Portal hypertension}}
{{Portal hypertension}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{EG}}


==Overview==
==Overview==
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==Differentiating Portal Hypertension from other Diseases ==
==Differentiating Portal Hypertension from other Diseases ==
* Portal hypertension must be differentiated from other diseases that cause [[ascites]], [[splenomegaly]], [[hematemesis]] or [[melena]], [[bacterial peritonitis]], [[hydrothorax]], [[hypoxemia]], and [[pulmonary hypertension]].  
* Portal hypertension must be differentiated from other diseases that cause [[ascites]], [[splenomegaly]], [[hematemesis]] or [[melena]], [[bacterial peritonitis]], [[hydrothorax]], [[hypoxemia]], and [[pulmonary hypertension]].  
* Portal hypertension must be differentiated from various diseases as in the following table.<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref>
* Portal hypertension must be differentiated from various diseases as in the following table.<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref><ref name="pmid12872092">{{cite journal |vauthors=Lee YT, Walmsley RS, Leong RW, Sung JJ |title=Dieulafoy's lesion |journal=Gastrointest. Endosc. |volume=58 |issue=2 |pages=236–43 |year=2003 |pmid=12872092 |doi=10.1067/mge.2003.328 |url=}}</ref><ref name="pmid8277955">{{cite journal |vauthors=Runyon BA |title=Care of patients with ascites |journal=N. Engl. J. Med. |volume=330 |issue=5 |pages=337–42 |year=1994 |pmid=8277955 |doi=10.1056/NEJM199402033300508 |url=}}</ref><ref name="pmid9735689">{{cite journal |vauthors=O'Reilly RA |title=Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients |journal=West. J. Med. |volume=169 |issue=2 |pages=88–97 |year=1998 |pmid=9735689 |pmc=1305177 |doi= |url=}}</ref><ref name="pmid19897273">{{cite journal |vauthors=Soriano G, Castellote J, Alvarez C, Girbau A, Gordillo J, Baliellas C, Casas M, Pons C, Román EM, Maisterra S, Xiol X, Guarner C |title=Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management |journal=J. Hepatol. |volume=52 |issue=1 |pages=39–44 |year=2010 |pmid=19897273 |doi=10.1016/j.jhep.2009.10.012 |url=}}</ref><ref name="pmid18988781">{{cite journal |vauthors=Azfar Ali H, Lippmann M, Mundathaje U, Khaleeq G |title=Spontaneous hemothorax: a comprehensive review |journal=Chest |volume=134 |issue=5 |pages=1056–1065 |year=2008 |pmid=18988781 |doi=10.1378/chest.08-0725 |url=}}</ref><ref name="pmid16052273">{{cite journal |vauthors=Rodríguez-Roisin R, Roca J |title=Mechanisms of hypoxemia |journal=Intensive Care Med |volume=31 |issue=8 |pages=1017–9 |year=2005 |pmid=16052273 |doi=10.1007/s00134-005-2678-1 |url=}}</ref><ref name="pmid24355639">{{cite journal |vauthors=Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Gomez Sanchez MA, Krishna Kumar R, Landzberg M, Machado RF, Olschewski H, Robbins IM, Souza R |title=Updated clinical classification of pulmonary hypertension |journal=J. Am. Coll. Cardiol. |volume=62 |issue=25 Suppl |pages=D34–41 |year=2013 |pmid=24355639 |doi=10.1016/j.jacc.2013.10.029 |url=}}</ref>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Jaundice]]
| style="background: #F5F5F5; padding: 5px;" |[[Jaundice]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''[[K]], [[Sodium|Na]]
| style="background: #F5F5F5; padding: 5px;" |'''↑'''[[K]], [[Sodium|Na]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |[[Exudate]]
| style="background: #F5F5F5; padding: 5px;" |[[Exudate]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Sweating]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |[[Microcytic anemia]]
| style="background: #F5F5F5; padding: 5px;" |[[Microcytic anemia]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑[[Hemoglobin A2|HGB-A2]]'''
| style="background: #F5F5F5; padding: 5px;" |'''↑[[Hemoglobin A2|HGB-A2]]'''
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |Sickle [[RBC]]
| style="background: #F5F5F5; padding: 5px;" |Sickle [[RBC]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Bone pain]]
| style="background: #F5F5F5; padding: 5px;" |[[Bone pain]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |[[Spherocyte]]
| style="background: #F5F5F5; padding: 5px;" |[[Spherocyte]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Osmotic fragility test
| style="background: #F5F5F5; padding: 5px;" |Osmotic fragility test
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''↓'''
| style="background: #F5F5F5; padding: 5px;" |'''↓'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Dyspepsia]]
| style="background: #F5F5F5; padding: 5px;" |[[Dyspepsia]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Hx of [[vomiting]]
| style="background: #F5F5F5; padding: 5px;" |Hx of [[vomiting]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''↓↓'''
| style="background: #F5F5F5; padding: 5px;" |'''↓↓'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Changing bowel habit
| style="background: #F5F5F5; padding: 5px;" |Changing bowel habit
|-
|-
Line 248: Line 248:
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Exudate]]
| style="background: #F5F5F5; padding: 5px;" |[[Exudate]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+++
| style="background: #F5F5F5; padding: 5px;" | +++
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Abdominal guarding|Guarding]]
| style="background: #F5F5F5; padding: 5px;" |[[Abdominal guarding|Guarding]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''↓↓'''
| style="background: #F5F5F5; padding: 5px;" |'''↓↓'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[chest pain]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest pain]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis|'''Sarcoidosis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis|'''Sarcoidosis''']]
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| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
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| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |Bilateral hilar [[adenopathy]]
| style="background: #F5F5F5; padding: 5px;" |Bilateral hilar [[adenopathy]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |'''↓'''
| style="background: #F5F5F5; padding: 5px;" |'''↓'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" |'''↑↑'''
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |'''↑'''[[K]], [[Sodium|Na]]
| style="background: #F5F5F5; padding: 5px;" |'''↑'''[[K]], [[Sodium|Na]]
|-
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Ejection fraction|EF]]<40%
| style="background: #F5F5F5; padding: 5px;" |[[Ejection fraction|EF]] < 40%
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS depression|'''Central nervous system depression''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[CNS depression|'''Central nervous system depression''']]
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==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:needs content]]
[[Category:Emergency medicine]]
 
[[Category:Up-To-Date]]
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Latest revision as of 14:10, 7 December 2017

Portal Hypertension Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Portal hypertension must be differentiated from other diseases that cause ascites, splenomegaly, hematemesis or melena, bacterial peritonitis, hydrothorax, hypoxemia, and pulmonary hypertension. Diseases that must be differentiated from portal hypertension are malignant ascites, nephrogenic ascites, tuberculosis, thalassemia, sickle cell disease, hereditary spherocytosis, peptic ulcer disease, Mallory-Weiss tear, colorectal cancer, secondary bacterial peritonitis, malignant hydrothorax, sarcoidosis, nephrotic syndrome, heart failure, central nervous system depression, muscular weakness, idiopathic pulmonary hypertension, valvular heart disease, and connective tissue disease.

Differentiating Portal Hypertension from other Diseases

Differentiating symptom Diseases Laboratory Findings Physical Examination History and Symptoms Other Findings
CBC ESR Alb Iron Ascites fluid PBS Cr Abdominal tenderness Pale conjunctiva Fever Pitting edema Apnea/

Baradypnea

Murmur Weight loss Weakness Cough Dyspnea
Portal Hypertension - - - - Transudate - ↑ + - - - - - - - - - Cirrhosis
Ascites Malignant ascites - ↑↑ ↓ - Exudate - - - - - - +/- - + + - - Jaundice
Nephrogenic ascites - - ↓↓ ↓ Exudate - ↑↑ - + - ++ + - - + - - ↑K, Na
Tuberculosis ↑lymph. ↑ ↓ - Exudate - - - - + - + - + + ++ + Sweating
Splenomegaly Thalassemia ↓MCV

↓HGB

- - ↓ - Microcytic anemia - - + - - - - - + - - ↑HGB-A2
Sickle cell disease ↓HGB - - ↓ - Sickle RBC - + + + - - - - + - + Bone pain
Hereditary spherocytosis ↓MCV

↓HGB

- - ↓ - Spherocyte - - + - - - - + + - - Osmotic fragility test
Hematemesis/ Melena Peptic ulcer disease ↓HGB - - ↓ - - - + + - - - - + + - - Dyspepsia
Mallory-Weiss tear - - - - - - - + - - - - - - - - - Hx of vomiting
Colorectal cancer ↓HGB ↑↑ ↓ ↓↓ - - - - + - - - - + + - - Changing bowel habit
Bacterial peritonitis Secondary bacterial peritonitis ↑Neut. ↑ - - Exudate - - ++ + +++ - + - - + - - Guarding
Hydrothorax Malignancy ↑↑WBC ↑↑ ↓↓ - - - - - + - - + - + + + + Chest pain
Sarcoidosis ↑WBC ↑↑ - - - - ↑ - + - - + - + + + + Bilateral hilar adenopathy
Nephrotic syndrome - ↑ ↓↓ ↓ - - ↑↑ - + - ++ - - - + - - ↑K, Na
Hypoxemia Heart failure - - - - - - - - - - ++ - + + + + + EF < 40%
Central nervous system depression - - - - - - - - - - - + - - - - + Opioid overdose
Muscular weakness - - - - - - - - - - - - - + ++ - - Neuromuscular disease
Pulmonary hypertension Idiopathic pulmonary arterial hypertension - ↑ - - - - - - - - - - - + + + + Hemoptysis
Valvular heart disease - - - - - - - - - - - - ++ - + - - Dyspnea on exertion
Connective tissue diseases - ↑ - - - - ↑ - - - - - + - + - - Aortic dissection

References

  1. ↑ Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB (2004). "The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated". Gastrointest. Endosc. 59 (7): 788–94. PMID 15173790.
  2. ↑ Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G (2008). "An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium". Gastrointest. Endosc. 67 (3): 422–9. doi:10.1016/j.gie.2007.09.024. PMID 18206878.
  3. ↑ Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
  4. ↑ Wollenman CS, Chason R, Reisch JS, Rockey DC (2014). "Impact of ethnicity in upper gastrointestinal hemorrhage". J. Clin. Gastroenterol. 48 (4): 343–50. doi:10.1097/MCG.0000000000000025. PMC 4157370. PMID 24275716.
  5. ↑ Lee YT, Walmsley RS, Leong RW, Sung JJ (2003). "Dieulafoy's lesion". Gastrointest. Endosc. 58 (2): 236–43. doi:10.1067/mge.2003.328. PMID 12872092.
  6. ↑ Runyon BA (1994). "Care of patients with ascites". N. Engl. J. Med. 330 (5): 337–42. doi:10.1056/NEJM199402033300508. PMID 8277955.
  7. ↑ O'Reilly RA (1998). "Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients". West. J. Med. 169 (2): 88–97. PMC 1305177. PMID 9735689.
  8. ↑ Soriano G, Castellote J, Alvarez C, Girbau A, Gordillo J, Baliellas C, Casas M, Pons C, Román EM, Maisterra S, Xiol X, Guarner C (2010). "Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management". J. Hepatol. 52 (1): 39–44. doi:10.1016/j.jhep.2009.10.012. PMID 19897273.
  9. ↑ Azfar Ali H, Lippmann M, Mundathaje U, Khaleeq G (2008). "Spontaneous hemothorax: a comprehensive review". Chest. 134 (5): 1056–1065. doi:10.1378/chest.08-0725. PMID 18988781.
  10. ↑ Rodríguez-Roisin R, Roca J (2005). "Mechanisms of hypoxemia". Intensive Care Med. 31 (8): 1017–9. doi:10.1007/s00134-005-2678-1. PMID 16052273.
  11. ↑ Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Gomez Sanchez MA, Krishna Kumar R, Landzberg M, Machado RF, Olschewski H, Robbins IM, Souza R (2013). "Updated clinical classification of pulmonary hypertension". J. Am. Coll. Cardiol. 62 (25 Suppl): D34–41. doi:10.1016/j.jacc.2013.10.029. PMID 24355639.

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